My Turn: Block grants for Medicaid would injure the vulnerable


For the Concord Monitor

Wednesday, January 25, 2017

A serious threat to seniors and those with disabilities is being ignored in the debate over repealing the Affordable Care Act.

photo from Hanover Hills Health Center

We must not forget that the Medicaid program dates back to 1965, not the ACA expansion for the working poor. This half-century-old safety net is responsible for more than three-fifths of all nursing home patients, and it, too, is imperiled.

The incoming secretary of federal Health and Human Services, Congressman Tom Price, a Georgia Republican, favors rationing Medicaid through “block grants.”

Presently, state Medicaid spending is matched by the federal government in an income-based formula. Poor states get more, affluent states get less. A block grant effectively freezes the federal contribution for each state, leaving states with no incentive to improve Medicaid funding.

Block grants would injure the vulnerable in all states, but particularly states like New Hampshire, where the federal participation in Medicaid spending is only 50 percent. By freezing the federal contribution, block grants would forever advantage states with higher matching rates, such as Price’s Georgia, where the federal government pays 67.9 percent of all Medicaid costs.

In New Hampshire, the nation’s second-oldest state, the state’s payment shortfall has exacerbated a crisis in staff recruitment and retention. This is a state that somehow manages to even shortchange, by hundreds of thousands of dollars, the care costs of a 40-bed facility for Catholic nuns.

Arguably it values prison care more – the recent 15 percent wage increase for prison nurses is more than twice what the increase in Medicaid rates has been for the past seven years.

Yet a compassionate public wants improved long-term care funding. A post-election poll of 800 New Hampshire voters found a plurality (43 percent) actually chose long-term care funding as their top legislative priority, and more than three-quarters (76 percent) of voters felt Medicaid costs should be fully reimbursed.

Unlike the federal government, states have to balance their budgets. While no states fund Medicaid generously under the best of circumstances, most cut it in economic downturns.

Because Medicaid is presently a federal-state partnership, the federal government, in theory, acts as a check upon the states’ worst impulses, both in its (seldom-exercised) right to reject Medicaid cuts, and because cuts lose a corresponding number of federal dollars. For nursing homes, most funding goes to the wages of caregivers and support staff, and they, in turn, spend that money in their local economies.

Yet the U.S. House budget proposal released last year by Congressman Price promoted unlimited state Medicaid discretion: “Governors and state legislatures know better than Washington bureaucrats how to serve their communities and where there are unmet needs.”

That sounds true, and may be true in many cases, but it ignores hard choices that too frequently confront states.

In New Hampshire, for example, a Democratic governor tried to cut nursing home care by millions of dollars in 2015 and was rebuffed by a Republican Legislature. But what if lost federal dollars had also not been at stake?

Block grants would encourage a sort of social Darwinism in an aging society where vulnerable populations, and their caregivers, would compete for diminishing resources. The reality is the entire system needs improved funding, whether it is in-home or facility-based care. This continuum of care is interdependent. Those cared for in their own homes need facility placements to be available if their care needs become more acute. In turn, where patients are rehabilitated, nursing homes must be able to discharge them to lighter-care settings.

Medicaid is essential to the infirm elderly and those with disabilities who lack the resources to pay for their own care. As advocates urgently seek to improve Medicaid funding here at home, we do not need care to be robbed of federal dollars.

(Brendan Williams is the president and CEO of the New Hampshire Health Care Association.)